Apology accepted on the all caps faux pax. We all were new at this at one time.

I am in the debate. Instead of offering anything of substance you merely repeat unsupported assertions, throw out irrelevant arguments, and ignore easily found case studies proving CAM is bogus. Then you have the temerity to accuse Brennen of being stubborn. My long post above was a sarcastic way of showing the weaknesses and fallacies in your arguments.

And I am not a brown noser. I’m sure several of my former managers would gladly attest to that.

Ok, what the heck. Foto, the debate is past the effectiveness of CAM. The debate is whether CAM has a place in todays medicine.
Obviously it does. Hence my NYT Mayo Clinic article. Not that anyone with a brain and 2 eyestalks needed that article. WE have been surrounded by CAM forever
MCKenzie, and others, possibly you too, have stated that there is no place for CAM in Medicine. Obviously that isn’t true. Scientists are sitting around researching it as we speak. The Worlds Top Hospitals are utilizing it in various capacities. Every nation on Earth has CAM.
It is one of the largest selling commodities.
So whether you choose to categorically shun CAM, or you are willing to accept that various CAM treatments are being accepted by science, and it is incorporated into treatments, or used soley as treatment, it doesn’t matter. Because CAM is a part of medicine.
The intensity of this debate centers around McKenz’s past complete shunning of CAM as Woo, or religious like etc…etc..etc…
Now I see he is revising his outlook, because he has figured out that the debate is about CAM having a place in medicine.
Above witness his concession that acupuncture may have some benefits.
We aren’t debating the effectiveness of CAM. We aren’t going to sit here and break down all the various types of CAM, and decide which ones are good, and which ones are Woo. We have used CAM as term meaning just what it stands for: Complimentary Alternative Meds.
So. I’ll ask you Fotobits: is there a place for CAM in medicine today? The answer is automatically yes.(because it’s there already-it always has been.)

Not that the truth or facts seem to affect you much, but there is no change in my position. Perhaps when I clarified and explained it in more detail, in response to your charicature of it, then you understood it better and it seemed different to you. I have been consistently making the same points as my last post all along.

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Post #1. I haven’t been particularly interested in the other CAM related topics, but it seems a bit strange that MacKenzie immediately attacks Vyazma: “*sigh* I know I’ll never convince you”, “I realize you are unable to believe that anyone could oppose CAM. . .”

Post #3. Mackenzie: “You’re just plain wrong here.” Might it not be a bit more courteous to ask the poster to document his statement rather than a rather boorish response to start an answer?

“In most cases, the trajectory is clear and predictable: suggestive in vitro and laboratory animal studies lead to initially positive results from small, poorly designed studies which are then overturned by larger, better-designed studies.” {My bold} Interesting qualification after the “You’re just plain wrong” comment.

“Another myth, and irrelevant even if it were true. . . . . Most of the vitamins and alternative diets are 20th century inventions.” However, drinking a brew made of a tree bark to remedy headaches was alternative medicine until the bark was found to contain salicylic acid. Sodium acetyl salicylate (aspirin) is now considered main stream. Similarly quinine was a folk remedy until it was discovered to protect against malaria. Much more recently tetrahydrocannabinol was moved from alternative medicine to mainstream when it was found to be more effective in combating the pain and nausea of some severe illnesses. I could go on for quite a while, listing items that started out as folk remedies but have become accepted by the medical establishment.

“As for stubborness, that’s just a silly ad hominem.” No that is not too precise, ad hominem means attack the person. If you go back, you’ll notice that Vyazma was speaking in general about the forum participants, not attacking a specific person.

Post #4. “Red herring” Sorry Fotobits, but while this was irrelevant, it wasn’t really ignoratio elenchii which appears to offer an argument toward a conclusion.

“Straw Man” No, Straw Man is presenting a weak. irrelevant or fallacious position as representing the other side than destroying it. This one is a Red Herring.

“Another red herring” Same error as above.

Post #5. “Brennen and fotobits have this spot on. Thanks.” Sorry, Doug, they’ve presented some valid points, but there were enough errors or off-the-point comments that I couldn’t accept a “spot on”.

Post #11. “As far as acupuncture, there is some evidence that is reduces subjective symptoms such as pain or nausea. It doesn’t measurably affect the underlying disease,” I’m not sure if this is supposed to be an argument against acupuncture as a valid treatment. If so, does this mean that MacKenzie also rejects aspirin, naproxyn, codeine, morphine, and other analgesics since most don’t measurably affect the underlying disease? I realize you qualified your statement later in the paragraph, but starting it off that way seems an interesting approach.

“. . .you have to acknowledge that I have never said all CAM is evil.” True. You didn’t, but you did say, [post #3] “You’re just plain wrong here. There is no burgeoning of studies showing CAM works. The nearly $2 billion dollars of taxpayer money the NIH’s NCCAM has spent researching it has yet to validate a single significant therapy in over 10 years.” That seems a relatively strong statement in the direction of “all cam is evil.”

“DSHEA (the Dietary Supplement Health and Education Act of 1994) severely limits the FDA’s authrity to regulate anything that can conceivably been identified as a food or supplement.” Ah yes, I recall a while before that the suggestion by the FDA that all vitamin pills above the RDA must prescribed by a doctor. Since that time, a number of those vitamins have had their RDAs raised significantly.

“Science is just a method to help us see past these, and it works.” I agree, but one problem is that people on all sides: CAM, Pharma, AND Bureaucracy all make mistakes, and all have personal agendas. This means the voice of science is often drowned out or warped for varying lengths of time.

Post #16. “As far as I can tell there aren’t many places on the internet where you get a chance to debate with an expert, which Brennen as a vet undoubtedly is.” Sorry, George, but I have a problem with the faith-based approach of accepting authority. I agree that MacKenzie is quite knowledgeable about CAM, but I seem to see a bit or more of an extremist true-believer viewpoint in his posts than I’m comfortable with.

Post #17. “I’ve been clear all along that there really is no “alternative” medicine; that’s just a PR term.” Really?? Have you noticed the title of this Sub-Forum? Perhaps you could ask Doug to rename it to be more accurate.

From here on the posts all devolve into personal criticisms and claims of having the superior position.

I feel that most of CAM is uninformed and has many of the criticisms listed here, but I also feel that Vyazma is MOST CERTAINLY NOT THE ONLY ONE GUILTY OF BEHAVING IN A BIT OF A TROLL FASHION. I agree with Doug that some chastisement was probably needed here because all of the participants should have been more gentle and less confrontational, but I disagree with his singling out one of the members of this argument.

In the interests of helping this thread die, I shall not respond to any comments made to this post.

I realize you have a personal fondness for VYZMA and dislike for me, and I know you’re a believer in the value of vitamin supplements and we’ve disagreed about that in the past, but I think you’re seeing this debate in a highly biased light. Of course, there is always room for different interpretations of tone in written communication, but the impression I get from George’s and fotobits’ and Doug’s comments is that your interpretation here is the idiosyncratic one. A quick review of the previous discussions VYAZMA and I have had in other ALT MED threads will show that there is a context to the remarks in this thread, and that he has persistantly refused to provide any evidence for his assertions and has repeatedly accused me, macgyver, and others CAM critics of being dupes or apologists for the pharmaceutical industry and other such nonsense.

Your chiding of me, then, represents your personal feelings far more than an objective assessment of the tone of these discussions. I notice that you selected only comments critical of VYAZMA (overwhelmingly mine) and ignored his remarks, and then you had the cheek to chide Doug for “singling out one of the members of this argument.” That certainly smacks of “taking sides” on the basis of personal feelings more than rational analysis of the debate. And I find your announced refusal to respond to any comments made not a noble attempt to avoid conflict (which would have been better served by not making the post in the first place) but just a cheap way to say your say and ignore any counter arguments. You and VYAZMA certainly do practice a similar style of debate!

As for specifics (not that you care, of course, but in the interest of accuracy):

Might it not be a bit more courteous to ask the poster to document his statement rather than a rather boorish response to start an answer?

I’ve asked many times, in this thread and others, and he has refused. “Boorish” is your axe-grinding intepetation. Exasperated would be more accurate.

However, drinking a brew made of a tree bark to remedy headaches was alternative medicine until the bark was found to contain salicylic acid.

No, it was not alternative, it was folk medicine in the days before scientific medicine existed. When it was purified and standardized, it became the much safer and more effective medicine it now is. I defy you to find anywhere I’ve claimed we shouldn’t attempt to isolate pharmacologically active compounds from plants. However, I prefer taking aspirin to drinking willow bark tea, so anyone who recommends the former today is practicing CAM, and it is not appropriate. I also notice that you fail to recognize the far greater number of folk remedies that have been abandoned or proven ineffective, so if your point is that they are justifiable because of the few investigations of them that lead to real medicine, it’s a weak point.

As for stubborness, that’s just a silly ad hominem.” No that is not too precise, ad hominem means attack the person. If you go back, you’ll notice that Vyazma was speaking in general about the forum participants, not attacking a specific person.

If you review the thread, you’ll see that only I had responded to his posts and that, in combination with the context I mentioned earlier, makes it quite reasonable to read the remark as directed at myself. Certainly other posters in the thread read it that way as well.

I’m not sure if this is supposed to be an argument against acupuncture as a valid treatment. If so, does this mean that MacKenzie also rejects aspirin, naproxyn, codeine, morphine, and other analgesics since most don’t measurably affect the underlying disease?

Nonsense! NSAIDs and opiods have measurable and well-understood physiological effects and are used specifically for those effects. Acupuncture has primarily non-specific psychological effects and yet is routinely trumpeted as a “cure” for innumerable illnesses. I was simply restating a position I have articulated many times indicating that contrary to VYAZMA’s charicature of my position, I do not blindly and automatically oppose CAM therapies but evaluate them according to the quality of the evidence they provide for their claims, and this is the extent of what the evidence for acupuncture supports. This looks a lot like another attempt to set up a strawman of my position to bash at.

The nearly $2 billion dollars of taxpayer money the NIH’s NCCAM has spent researching it has yet to validate a single significant therapy in over 10 years.” That seems a relatively strong statement in the direction of “all cam is evil.”

You can take it that way if you like, but it means exactly what it says. VYAZMA held out the NCCAM as an example of why CAM is really mainstream and legitimate and then claimed there was a “burgeoning” of positive scientific studies to validate it. I simply pointed out why the NCCAM is not a reliable authority and that even it has failed to provide the evidence he claims exists.

Ah yes, I recall a while before that the suggestion by the FDA that all vitamin pills above the RDA must prescribed by a doctor. Since that time, a number of those vitamins have had their RDAs raised significantly.

I know you won’t care, but for anyone else interested, HERE is an extensive (though by no means complete) list of resources illustrating the harm that CAM can do, including a section on vitamins and supplements exempted from regulation by DSHEA. The book I recommended earlier by Dan Hurley is also a good resource, as is this essay on megadose vitamin therapy inparticular.

Science carefully works to discover its own misconceptions and changes recommendations as the evidence warrants. This is not a fault or a justification of CAM, which more often takes folk wisdom, tradition, anecdote, and wild guesses and elevates it to unquestionable dogma. I prefer some reasonable regulation to a caveat emptor free-for-all, but I’m clearly in the minority in America on that.

I seem to see a bit or more of an extremist true-believer viewpoint in his posts than I’m comfortable with.

You may see that, but it’s not true. If you browsed my own site and blog, you’d see polite, reasoned evaluations. I am often taken to task by others who try to oppose unproven therapies for being to gentle, and here you characterize me as an extremist. Such is the fate of a true moderate!

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Brennen is right here. Sure, some of what we consider modern medicine was at one time folk remedy. One shouldn’t emphasize this too much—that kind of argument gets brought up a lot, however of the thousands of drug compounds out there, only a small percentage were ever really folk remedies, aspirin and quinine being two of the most famous, over a century ago (It’s hardly recent history). But that’s neither here nor there. The point is that those compounds were tested and found to work—we understand their method of action.

The point about CAM is that in order to be considered CAM a treatment has not to have been proven effective. Once a treatment is proven effective, it is no longer CAM, but instead becomes part of the medical establishment, and part of established medical practice.

What that means is that, of course, it can’t be the case that of necessity everything falling under the CAM rubric is ineffective. But since much of it has already been tested and found wanting, we know already that much of it is, in fact, ineffective. And since of any given untested CAM product we know that it is most likely ineffective (the vast majority of tested products are ineffective) it is wrong to claim they can treat or cure disease, in advance of the evidence.

(And yes, as I’ve argued with Vitamin D, there are some in-between cases where the evidence is somewhat strong, and accepted by places like Harvard and Berkeley, but perhaps not completely nailed down. Then we as individuals have to make the determination of the cost/benefit analysis. But at all accounts, we shouldn’t be doing that instead of taking a proven medication).

Re. the difference between placebo and morphine, it could not be greater. According to Dr. Mark Crislip of Quackcast, placebo medication only works on the subjective belief one has about pain, not on any objective endpoint. That is, people who are given placebo will say that they feel less pain on average, but they will require the same amount of pain medications—e.g., morphine—that they did before the placebo. So basically one should look at the placebo effect as not unlike a “make the doctor feel happy” effect. People tell the doctor what they think he wants to hear. He’s given me something, so it must be helping me, so I’ll say I feel better. That’s more or less the placebo effect in a nutshell, and as a result it does not and cannot work as well as an actual painkiller. (And of course, painkillers are tested against placebo and have to work better than placebo in order to be accepted by the FDA).

There’s too much emphasis being placed on CAM’s effectiveness in relation to prescription meds, or surgical techniques etc.
CAM’s role in medicine, as it always has been, is to “compliment” regular medicines.
What benefits does this have?
1. Deflection of subjective cases away from practical field. I think anyone can understand the benefits of this in these reform minded economic/socio-political climates. In fact, as anyone could well see there isn’t enough deflection!
2. Broadens a Health Care Units Marketability. In this growing world of consumerism, and information age populations, people are seeking out alternative solutions. This will give thousands and thousands of new Health Professionals a way to market a commodity.
Hospitals, Clinics and Private practices, will be able to offer a wider range of products to sell, or administer to their patients.
3. Comfort in palliative settings, or hospice settings. The potential for saving billions of dollars in Health Care/Ins. costs is obviously spectacular!
All of this can be wrapped up in the package of Consumerism. Consumerism which is the Final agent in deciding what is available to the public. So in this light, that is all that matters. Taking in to consideration that these CAMs have always been around, and they are not going to be outlawed(in fact are being incorporated into the health care system), that they are items which can be exploited to further the comfort, and piece of mind, of willing users; it is pointless to say “That doesn’t make it right!”
How we became a society of the Sick is probably the most complicated issue. Why we became a population of “symptom seekers”, or “health conscious people” is an interesting study. But we are!- along with other nations.
We still have Hunter-gatherer behavioral traits, and we still seek out spiritualism. CAM does a great job of filling both of these needs.
Arguing whether these items are effective is redundant. These items ARE effective in other areas of the Social-economic fabric.
Highly effective.

OK, now we may be getting somewhere. So then are we in agreement that CAM should not be marketed as effective in relation to “prescription meds, surgical techniques, etc.”? And that it is wrong, and indeed should be illegal, to do so in the absence of clinical data showing such effect?

Re. palliative care and deflecting the “worried well” away from the hospital: there is a fine line between providing comfort, psychological counseling and perhaps stress relief techniques on the one hand, and many of what are usually considered CAM techniques on the other; e.g., the list HERE. Those selling the techniques on that list do not claim solely to provide comfort. They actively claim to treat or cure disease.

And as regards the “worried well” or hypochondriacs, what they require is professional psychological counseling, if what we’re after is saving the medical system money. I am not aware of any evidence that CAM techniques cure anyone of hypochondria. What they do is to require the patient to return to the CAM practitioner for further treatments, essentially forever. That costs money, it doesn’t save money. Again, that would be fine if there were some reason to assert that the symptoms of hypochondria were being alleviated. Is there data to assert this? If so, I am unfamiliar with it, and certainly it would depend on the particular treatment at issue. It won’t generalize.

I am willing to grant that there is something of a grey area, techniques perhaps not on that list but useful in hospices. (E.g., religious counseling for believers, meditation). However, we know of some that are also useless or dangerous, for example the actually harmful techniques of the Gonzalez Therapy that Brennen mentioned, above. It is a CAM technique that actually managed to shorten and worsen the lives of people with terminal pancreatic cancer. It is apparently still being sold through Gonzalez’s website.

So while some grey area CAM therapies may be useful for palliative care or the “worried well”, they should never be oversold, as virtually all these therapies are. There should also be studies undertaken to be sure that the therapies are at least not harmful, as Gonzalez’s therapy is, and as chiropractic and acupuncture can be.

Consumerism which is the Final agent in deciding what is available to the public. So in this light, that is all that matters. Taking in to consideration that these CAMs have always been around, and they are not going to be outlawed(in fact are being incorporated into the health care system), that they are items which can be exploited to further the comfort, and piece of mind, of willing users; it is pointless to say “That doesn’t make it right!”

I really don’t understand this. I’ve said before this sounds like libertarian economics in which people should be free to buy and sell whatever they want without any protection against fraud, but you claimed I was unfairly putting words in your mouth. If somebod sells something like blackroot salve and claims it will cure your skin cancer, but instead it leaves you with a horrible disfiguring burn on your face and still with cancer cells present, isn’t this wrong? Shouldn’t this be illegal? Does the fact that people believe the lies and want to buy the product make selling it ok?

We still have Hunter-gatherer behavioral traits, and we still seek out spiritualism. CAM does a great job of filling both of these needs.
Arguing whether these items are effective is redundant.

How can you say this and then be offended when I compare CAM to religion? You’re saying that it doesn’t matter whether it works so long as people feel good about using it, and that is a kind of religous faith.

If these are accurate reflections of your point of view, then our disagreement is essentially about values, not CAM per se. You seem to have backed away from arguing that CAM really is effective (which I don’t think there is supportive evidence) to arguing that it doesn’t matter if it makes people happy. Not surprisingly, I disagree.

I believe people should’t be allowed to sell sick, desperate folks fake cures that give them psychological comfort as placebos without actually helping them. This is wrong even if the people doing the selling are being deliberately deceitful because studies, such as the recent one on the Gonzalez protocol, show that it prevents people from getting the real comfort and benefits of scientific medical care. Integrating magical thinking with scientific medicine is doomed to fail, and of the two I think science has more to offer in the way of real help for the sick.

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OK, now we may be getting somewhere. So then are we in agreement that CAM should not be marketed as effective in relation to “prescription meds, surgical techniques, etc.”? And that it is wrong, and indeed should be illegal, to do so in the absence of clinical data showing such effect?

The vast majority of items you would like to see illegal are not illegal. Due to our political/legal machinery laws are written so that products can be marketed and described for the public. If any products are breaking these laws they are usually dealt with in a timely fashion. Otherwise, buyer beware, or “be satisfied, or return your product for a full refund”. Etc..
The Vastmajority of these therapies or items are harmless. The public continues to use them- thus proving their utility in a Consumer driven population. As I said all harmful products are taken off the market in a usually timely fashion here- be they tricycles, pills, or seatbelts.

Re. palliative care and deflecting the “worried well” away from the hospital: there is a fine line between providing comfort, psychological counseling and perhaps stress relief techniques on the one hand, and many of what are usually considered CAM techniques on the other; e.g., the list HERE. Those selling the techniques on that list do not claim solely to provide comfort. They actively claim to treat or cure disease.

And these fine gradients are part of what’s making the health care system dysfunctional. The lines need to be roughened up a bit.
I’m talking about the active placation of the worried well, or the placation of those who are nearing the end, who are burdensome.

And as regards the “worried well” or hypochondriacs, what they require is professional psychological counseling, if what we’re after is saving the medical system money. I am not aware of any evidence that CAM techniques cure anyone of hypochondria. What they do is to require the patient to return to the CAM practitioner for further treatments, essentially forever. That costs money, it doesn’t save money. Again, that would be fine if there were some reason to assert that the symptoms of hypochondria were being alleviated. Is there data to assert this? If so, I am unfamiliar with it, and certainly it would depend on the particular treatment at issue. It won’t generalize.

Not if thousands of them never turned to a “practitioner” to begin with! But only buy St.Johns Wort, magnetic jewelry, and yes Kinoki Foot Pads. I’m under the impression that this very well could be the case in a percentage.
But assuming they go to a “practitioner”- Lots more Insurance Doesn’t cover this stuff. It is usually considerably cheaper than “Traditional Meds” anyways. The NIH site says CAM expenditures account for 34 Billion a year less than 1.5% of overall health exp.

I am willing to grant that there is something of a grey area, techniques perhaps not on that list but useful in hospices. (E.g., religious counseling for believers, meditation). However, we know of some that are also useless or dangerous, for example the actually harmful techniques of the Gonzalez Therapy that Brennen mentioned, above. It is a CAM technique that actually managed to shorten and worsen the lives of people with terminal pancreatic cancer. It is apparently still being sold through Gonzalez’s website.

I was hoping we could avoid hyperbolic “Tragedy” scenarios, as they are apparent on both sides of the argument. Instead we should evaluate the overwhelming innocuos treatments that Make up CAM- be they herbs, crystals, vitamins, karmas, or roots, massages, touchings, laying on of hands etc…

So while some grey area CAM therapies may be useful for palliative care or the “worried well”, they should never be oversold, as virtually all these therapies are. There should also be studies undertaken to be sure that the therapies are at least not harmful, as Gonzalez’s therapy is, and as chiropractic and acupuncture can be.

Again, I agree with this, however harm is relative matter in this debate. One could argue it was a relative matter in the case of terminal patients as well.

As I said all harmful products are taken off the market in a usually timely fashion here

I wish this were true, but it isn’t. The FDA simply doesn’t have the resources to police the laws regarding unsupported medical claims. I suspect you haven’t and won’t look at the references I’ve provided, but the fact is that harm is often done by these products and they do not disappear, either due to regulation or consumers getting wise to their unsafe and unhelpful nature. Heck, bleeding for any and all illness was happily practiced and accepted as therapy for over a thousnd years in Europe and later in early Amercia, and it undeniably did more harm than good. Science is simply more reliable than our personal impressions in determining the truth about such things.

the placation of those who are nearing the end, who are burdensome…harm is relative matter in this debate. One could argue it was a relative matter in the case of terminal patients as well.

Are you suggesting that it doesn’t matter if CAM therapies help or harm when the patient is going to die anyway? That seems cruel to me. The reason Doug and I keep mentionng the Gonzalez protocol sudy is it is an example of exactly this situation. Scientific medicine gave people with terminal pancreatic cancer on average 14 mos with pretty good quality of life. The CAM treatment gave them 4 months with much unecessary suffering. Is that right?

As for most CAM therapies being harmless, that is 1) unproven, and 2) only talkinga bout direct harm. The indirect harm that comes from accepting the magical theories behind them and then avoiding real medical therapy is real too. A Recent Study found that children seeing naturopaths and chiropractors had significantly lower rates of vaccination for preventable childhood diseases, and those seeing naturopaths or who had family members using any kind of CAM had higher rates of vaccine-preventable diseases. The people who seek out CAM often distrust science and scientific medicine, and CAM providers often discourage using real medicine, so even if the treatments thmselves are sometimes harmless, the point of view they sell isn’t.

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As for most CAM therapies being harmless, that is 1) unproven, and 2) only talkinga bout direct harm. The indirect harm that comes from accepting the magical theories behind them and then avoiding real medical therapy is real too. A Recent Study found that children seeing naturopaths and chiropractors had significantly lower rates of vaccination for preventable childhood diseases, and those seeing naturopaths or who had family members using any kind of CAM had higher rates of vaccine-preventable diseases. The people who seek out CAM often distrust science and scientific medicine, and CAM providers often discourage using real medicine, so even if the treatments thmselves are sometimes harmless, the point of view they sell isn’t.

Your only continued resource in this debate is shining a light on the harmful effects of CAM.
Can you prove that CAM providers often discourage patients from using real medicine?
I have ceased calling attention to the harmful effects of traditional meds. An effect which undoubtedly supports people in their choice of CAMs.( I mentioned above how the Negative aspects are relative to both sides of the debate.)

Your continued use of the Gonzales argument is reminiscent of frantic people describing in great detail the clubs which fur traders use to beat baby seals with. I have stated sufficiently that I understand that a product should be outlawed if it shown to be harmful.
Obviously!